ArticlesPredictive Factors and Long-Term Outcome of Respiratory Failure after Guillain-Barré Syndrome
Section snippets
Patients and Methods
We retrospectively reviewed the electrodiagnostic studies and medical records of 77 adult patients with GBS admitted to the Chang Gung Memorial Hospital in Kaohsiung between January 1987 and December 2001. This facility, the largest medical center in southern Taiwan, is a 2482-bed acute-care teaching hospital that provides both primary and tertiary referral care of patients. Among the 77 adult patients, 25 suffered from respiratory failure and were in need of respiratory support during the
Results
Of 77 patients with GBS, 25 (32%) required mechanical ventilation, including 15 male and 10 female patients with a mean age of 51.1 ± 22.2 years (range, 17–88 years). Among these 25 cases, an antecedent event was reported in 9 cases (36%). The following preceding events were found: upper respiratory infection (seven cases), herpes zoster infection (one case), and urinary tract infections (one case). The presenting clinical features on admission, in decreasing order of frequency, were pain or
Discussion
Guillain-Barré syndrome is the most common peripheral neuropathy causing respiratory failure.1 Mechanical ventilation has been reported to be administered to about 20% to 30% of patients in different series,2., 3. and it accounted for 32% (25/77) of our adult patients. Furthermore, fatality rates for GBS patients requiring mechanical ventilation for respiratory failure has been estimated to be around 15% to 30%,9., 10., 11., 12. although in our study, it accounted for 12% of the episodes.
It is
Conclusion
Contrary to the established belief that patients with GBS usually recover, several hospital-treated patients die or present residua even several months after the onset of symptoms. Factors that predict respiratory failure in our GBS patients were disability grade on admission and areflexia. Those patients who had low values of PImax and PEmax at the time of intubation and who had complications after mechanical ventilation inevitably had poor outcome. When patients have a low PImax (< 14.5 cmH2O)
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